Four acute conditions that bronchial hygiene is indicated are:
Ventilator associated Pneumonia ( VAP) is pneumonia that is acquired after 48 hours of being place on the ventilator. It is the most common nosocomial infection in the Intensive Care Units “ The risk for pneumonia increases 3 – 10-fold in patients receiving mechanical ventilation” ( Auguston, B.2007 ). Mechanical ventilation negates effective cough reflexes. This leads to micro aspiration of organisms into the lungs.
Atelectasis is a condition when one or more areas of the lung collapse, or don’t inflate properly. Atelectasis can be caused by a blocked airway ( obstructive) or from pressure outside the lung (non-obstructive). Obstructive atelectasis can be caused by a mucus plug or a foreign body. Non-obstructive can be caused by a pleural effusion, pneumothorax or sedatives.
Acute bronchitis is an inflammation in the bronchioles and is caused by a virus.” Acute bronchitis typically lasts less than 10 days, but coughing can last for weeks” (Lou, E. 2017). Acute bronchitis is characterized by a dry hacking cough, shortness of breath, chest tightness, and expiratory wheezing.
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2012). Bronchiolitis is common in the winter months between November and March. This previously healthy infant is showing signs and symptoms of a runny nose, cough, wheezing, fever and difficulty breathing. The parents report that the child has not eaten in a couple of days either. Bronchiolitis is diagnosed by clinical symptoms. This means it is usually diagnosed from history and medical examination. A few characteristics of bronchiolitis are the age of the patient. Most bronchiolitis patients are under 2 years of age, and have cough, runny nose, wheezing, fever, tachycardia and decreased oxygen
VAP develops in a patient after 48 hours or more of endotracheal intubation. According to a study by Relio et al. (as citied in Fields, L.B., 2008, Journal of Neuroscience Nursing, 40(5), 291-8) VAP adds an additional cost of $29,000-$40,000 per patient and increases the morality rate by 40-80%. Mechanically ventilated patients are at an increased risk in developing VAP due to factors such as circumvention of body’s own natural defense mechanisms in the upper respiratory tract (the filtering and protective properties of nasal mucosa and cilia), dry open mouth, and aspiration of oral secretions, altered consciousness, immobility, and possible immunosuppression. Furthermore, the accumulation of plaque in the oral cavity creates a biofilm that allows the patient’s mouth to become colonized with bacteria.
R.S. has chronic bronchitis. According to the UC San Francisco Medical Center “Chronic bronchitis is a common type of chronic obstructive pulmonary disease (COPD) in which the air passages in the lungs — the bronchi — are repeatedly inflamed, leading to scarring of the bronchi walls. As a result, excessive amounts of sticky mucus are produced and fill the bronchial tubes, which become thickened, impeding normal airflow through the lungs.” (Chronic Bronchitis 2015) There are many things that can be observed as clinical findings. R.S. will have a chronic cough that has lasted from 3 months to two years or more, and a lot of sputum. The sputum is due to
Ascertaining the adequacy of gaseous exchange is the major purpose of the respiratory assessment. The components of respiratory assessment comprises of rate, rhythm, quality of breathing, degree of effort, cough, skin colour, deformities and mental status (Moore, 2007). RR is a primary indicator among other components that assists health professionals to record the baseline findings of current ventilatory functions and to identify physiological respiratory deterioration. For instance, increased RR (tachypnoea) and tidal volume indicate the body’s attempt to correct hypoxaemia and hypercapnia (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). The inclusive use of a respiratory assessment on a patient could lead to numerous potential benefits. Firstly, initial findings of respiratory assessment reveals baseline data of patient’s respiratory functions. Secondly, if the patient is on respiratory medication such as salbutamol and ipratropium bromide, the respiratory assessment enables nurses to measure the effectiveness of medications and patient’s compliance towards those medications (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). Thirdly, it facilitates early identification of respiratory complications and it has the potential to reduce the risk of significant clinical
BiPAP is a form of noninvasive mechanical ventilation used on patients that have acute respiratory failure. Many of these patients go on noninvasive ventilation due to COPD exacerbations that are infectious, with congestive heart failure, and ventilator parameters based on their clinical assessment and changes in arterial blood gases. Two different studies were conducted on COPD patients, using a BiPAP machine to improve exacerbations and their activities of daily living. There are many positive outcomes for using these noninvasive ventilators however when used incorrectly, negative outcomes or not changes at all are always possible.
Ventilator-associated pneumonia (VAP) remains to be a common and potentially serious complication of ventilator care often confronted within an intensive care unit (ICU). Ventilated and intubated patients present ICU physicians, nurses, and respiratory therapists with the unique challenge to integrate evidence-informed practices surrounding the delivery of high quality care that will decrease its occurrence and frequency. Mechanical intubation negates effective cough reflexes and hampers mucociliary clearance of secretions, which cause leakage and microaspiration of virulent bacteria into the lungs. VAP is the most frequent cause of nosocomial infections and occurs within 48 hours of intubation. VAP is a major health care burden with its increased morbidity, mortality, longer ventilator days and hospital stay, and escalating health care cost.
Chronic bronchitis differs from emphysema in that it affects the bronchioles. There are two forms of bronchitis: chronic and acute. We are going to focus on chronic bronchitis. In this disease, the bronchioles become thick and inflamed. The affected person might cough up thick mucus which can also block the bronchioles.
My disease is Streptococcal pneumonia or pneumonia is caused by the pathogen Streptococcus pneumoniae. Streptococcus pneumoniae is present in human’s normal flora, which normally doesn’t cause any problems or diseases. Sometimes though when the numbers get too low it can cause diseases or upper respiratory tract problems or infections (Todar, 2008-2012). Pneumonia caused by this pathogen has four stages. The first one is where the lungs fill with fluid. The second stage causes neutrophils and red blood cells to come to the area which are attracted by the pathogen. The third stage has the neutrophils stuffed into the alveoli in the lungs causing little bacteria to be left over. The fourth stage of this disease the remaining residue in the lungs are take out by the macrophages. Aside from these steps pneumonia follows, if the disease should persist further, it can get into the blood causing a systemic reaction resulting in the whole body being affected (Ballough). Some signs and symptoms of this disease are, “fever, malaise, cough, pleuritic chest pain, purulent or blood-tinged sputum” (Henry, 2013). Streptococcal pneumonia is spread through person-to-person contact through aerosol droplets affecting the respiratory tract causing it to get into the human body (Henry, 2013).
Haas, D. F. (1990). The Chronic Bronchitis And EMPHYSEMA. New York,NY: John Wiley and Sons, Inc.
In normal breathing, the lungs expand and contract easily and rhythmically within the ribcage. To facilitate this movement and lubricate the moving parts, each lung is enveloped in a moist, smooth, two-layered membrane (the pleura). The outer layer of this membrane lines the ribcage, and between the layers is a virtually imperceptible space (the pleural space), which permits the layers to glide gently across each other. If either of your pleurae becomes inflamed and roughened, the gliding process is impeded and you are suffering from pleurisy. Pleurisy is actually a symptom of an underlying disease rather than a disease in itself. The pleurae may become inflamed as a complication of a lung or chest infection such as pneumonia or tuberculosis, or the inflammation may be caused by a slight pneumothorax or chest injury. The pleural inflammation sometimes creates a further complication by causing fluid to seep into the pleural space, resulting in a condition known as pleural effusion. However, pleurisy is not the only condition that can lead to pleural effusion, it may also be produced by diseases such as rheumatoid arthritis, liver or kidney trouble or heart failure. Even cancer spreading from the lung, breast or ovary can cause pleural effusion. If you have pleurisy, it hurts to breathe deeply or cough, and chest pain is likely to be severe. Accompanying the pain are any other symptoms associated with the underlying disorder. The pain will disappear if a pleural effusion occurs as a consequence of pleurisy, because fluid stops the layers of the pleura from rubbing against each other; however, you may become breathless as the fluid accumulates. In most cases, the risks are those of the underlying cause. A big pleural effusion can compress the lungs and cause breathlessness. Any effusion may lead to empyema. A chest X-ray examination may be required.
Liam is a previously healthy boy who has experienced rhinorrhoea, intermittent cough, and poor feeding for the past four days. His positive result of nasopharyngeal aspirate for Respiratory Syncytial Virus (RSV) indicates that Liam has acute bronchiolitis which is a viral infection (Glasper & Richardson, 2010). “Bronchiolitis is the commonest reason for admission to hospital in the first 6 months of life. It describes a clinical syndrome of cough tachypnoea, feeding difficulties and inspiratory crackles on chest auscultation” (Fitzgerald, 2011, p.160). Bronchiolitis can cause respiratory distress and desaturation (91% in the room air) to Liam due to airway blockage; therefore the infant appears to have nasal flaring, intercostal and subcostal retractions, and tachypnoea (54 breathes/min) during breathing (Glasper & Richardson, 2010). Tachycardia (152 beats/min) could occur due to hypoxemia and compensatory mechanism for low blood pressure (74/46mmHg) (Fitzgerald, 2011; Glasper & Richardson, 2010). Moreover, Liam has fever and conjunctiva injection which could be a result of infection, as evidenced by high temperature (38.6°C) and bilateral tympanic membra...
The Cumulative Index to Nursing and Allied Health Literature (CINAHL) was used to find peer-reviewed articles, using query terms such as: aspiration pneumonia, ventilator, and prevention. In addition, the TWUniversal search engine was utilized to find peer-reviewed articles, with the key words: aspiration pneumonia, ventilator, and enteral.
Pneumonia can also become a hospital acquired infection. Ventilator-associated pneumonia is a type of lung infection that occurs in a person who has been on a ventilator.... ... middle of paper ... ...
In review conducted by the Cochrane Collaboration, it was found that performing airway clearance techniques on patients with an acute episode of COPD reduced the likelihood of mechanical ventilation, as well as the length of time ventilation was needed (2012, p. 2).
Chronic bronchitis is a disorder that causes inflammation to the airway, mainly the bronchial tubules. It produces a chronic cough that lasts three consecutive months for more than two successive years (Vijayan,2013). Chronic Bronchitis is a member of the COPD family and is prominently seen in cigarette smokers. Other factors such as air pollutants, Asbestos, and working in coal mines contributes to inflammation. Once the irritant comes in contact with the mucosa of the bronchi it alters the composition causing hyperplasia of the glands and producing excessive sputum (Viayan,2013). Goblet cells also enlarge to contribute to the excessive secretion of sputum. This effects the cilia that carry out the mechanism of trapping foreign bodies to allow it to be expelled in the sputum, which are now damaged by the irritant making it impossible for the person to clear their airway. Since the mechanism of airway clearance is ineffective, the secretion builds up a thickened wall of the bronchioles causing constriction and increasing the work of breathing. The excessive build up of mucous could set up pneumonia. The alveoli are also damaged enabling the macrophages to eliminate bacteria putting the patient at risk for acquiring an infection.
A pneumothorax is defined as “the presence of air or gas in the plural cavity which can impair oxygenation and/or ventilation” (Daley, 2014). The development of a pneumothorax to a tension pneumothorax can be caused from positive pressure ventilation.